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r <br />1 <br />(he £��erAreen "� � N�T R U CT I O�+' <br />i,l�l'vF r . - <br />everet� p�RMIT PERMIT NO. 12760 <br />CITY HALL 259�8745 <br />EVERE7T, WA 98201 � COMBINATION ❑ BUILDING ❑ MECHANICAL ❑ PLUMBING <br />OWNER MAIL AO�RE55 CITY ZIP !MONE <br />RnNnv iFaum n 6123 EVERGREEN WAY EVERETT WA 9a203 355-5510 <br />GENEflAL C^NTFACTOR MAIL ADORESS CITY ZIP PNONE LICENSE N <br />MECHRNICALCONTRACTOR MAILADDRE55 CITY 21P PMONE LICENSEM <br />PIUMBING CONTRAGTOR MAIL AOOPE55 LITY 21P PMONE LICENSE N <br />,� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ DEMOLITION ❑ FENCE ❑ SIGN O WOOD STOVEIFIFEPLACE INSERT <br />S <br />Install grills, reach-in refri <br />Restaurant <br />�or _e�ocn _oF <br />6123 EVERGREEN WAY <br />PLUMBING <br />NO. TYPE OF FIXTURE OR <br />WATER CLOSET (TOILEn <br />BATHTUB <br />LAVATORY(WASHBASIN) <br />SHOWER <br />KITCHEN SINK 8 �ISP. <br />DISHWASHtR <br />LAUNORYTRAY <br />CLOTHES WASHER <br />WATER HEATEP <br />URINAL <br />DHINKING FOl1NTAIN <br />FLOOR �RAIN <br />VAGUUM BREAKERS <br />P.00F DRAINS — RAINLEA�ERS <br />SINK ISERVICE — BAR, ETC.) <br />SUB TOTAL <br />PERMIT <br />TOTAL fEE <br />OF <br />1. ENVIRONMENTAI CHECK LIST <br />2. BUILDING PLANS 'r <br />t-�— <br />3.FIREHYDRANT r <br />4. FIRE PRO7ECTlON SYSTEM <br />S.GRAOING! �� } <br />c� -� n � <br />W C m I <br />A <br />3-compartment sink <br />I HCREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS <br />APPLICATION AND KNOW THE SAME TO BE TRUE AND <br />CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES <br />GOVERNING THIS TYPE OF WORK WILL BE •^,•OMPLIED WITH <br />WHETHER SPECIFIED HEREIN OR NOT. THE tiRANTING OF A <br />PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE <br />OR CANCEL THE PROVISIONS OF ANY OTHER STPTE OR <br />LOCAL LAW REGULATI CONSTRUCTION OR THE <br />PERFORMs NCE OF C�(`� S UC ON. <br />__..._....�_fF..,.�..,.,....e.bG��.� oncn r.cur DATE <br />�S <br />REAR <br />GYES �iNO <br />MA%. <br />❑ NO <br />OATE <br />� <br />11 <br />NO. TYPE OF EOUIPMENT <br />AIR COND. UNI75 — H.P. EA. <br />pEFRIGERATION UNITS — H.P. EA. 3/QhC <br />BOILEFS — H.P. EA. <br />GAS FIRED A.C. UNITS — TONNAGE EA. <br />FORCED AIR SYSTEt�15 — B.7.U. M EA. <br />WALL HEA7ERS — B.T.U. M <br />UNIT HEATERS — B.T.U. M <br />EVAPORATIVE COOLERS <br />CLOTHES DRYEFS <br />VENTILATION FAN <br />RANGEHGOD <br />AIR HANDLING UNIT — C.F.M. <br />STOVE — WOOD <br />METAL FIREPLACE & CHIMNEY <br />FIREPLACEINSERT <br />HEAT PUMP <br />SUB TOTAL S <br />PENMIT f <br />TOTAL FEE 5 <br />FEE <br />IFEE I RECEIPT NO. <br />FEES VALUATION FEE <br />�� <br />BUILDING S <br />PWMBING 5 �JO <br />MECHANICAL <br />OTHER <br />U.B.C. <br />PENALTY SEC. 303 (a) <br />TOTA� 34 0 <br />PEFMIT VALIDA710N O <br />WHEN PROPERLY VALIDATED (IN THIS SPACE) 7HIS IS YOUR P[RMIT <br />4842 �005.00—� + <br />N <br />r� <br />Y�.�>U�; RFCEIPT <br />-, � !AR1K YOU <br />ADDRESS FILE <br />- � DtC 8 � <br />� <br />0 <br />